Diabetes - Gestational

DEFINITION

Gestational Diabetes is a form of diabetes which develops during pregnancy and usually goes away after the baby is born. Diabetes or diabetes mellitus is a metabolic disorder characterised by hyperglycaemia (high blood glucose levels) caused by impairment in insulin secretion and/or action.

DESCRIPTION

Women who develop Gestational Diabetes usually do so between the 24th and 28th week of pregnancy.
Risk factors associated with Gestational Diabetes include:.
- Obesity.
- Family history of diabetes.
- Age greater than 35 years.
- Previous history of Gestational Diabetes.
- Glycosuria (glucose in the urine) on two or more occasions.
- History of large babies (> 4 kg/9 pounds), unexplained stillbirth or neonatal death.
- Ethnicity. There is a significant difference in incidence and prevalence of Gestational Diabetes between ethnic groups.
It is important to know that Gestational Diabetes also occurs in pregnant women without these risk factors.

Women with Gestational Diabetes are at significant risk of developing diabetes later in life. To reduce this risk, women who have had Gestational Diabetes should exercise regularly, maintain a normal weight and avoid drugs that induce insulin resistance. They should also have blood glucose levels assessed regularly and should use effective contraception to avoid an unplanned pregnancy.

Poorly controlled Gestational Diabetes can increase the risk of the foetus/infant dying before, during or after the birth and can increase the risk of delivering large babies.

CAUSE

When a woman is pregnant, her energy needs increase. Her body is also producing hormones that interfere with insulin (the hormone needed to turn glucose into energy). During pregnancy, the amount of insulin needed by the mother is 2 to 3 times more than normal. If it is not possible for the mother's body to produce this insulin, diabetes develops. After the baby is born, the amount of insulin needed returns to normal and the diabetes usually goes away.

TREATMENT OPTIONS

In no way is this information intended to replace the advice of a medical practitioner. Always consult your Doctor for diagnosis and advice.
Gestational Diabetes is a potentially serious medical condition. Always consult your Doctor for diagnosis and treatment.
All women should be tested for diabetes between 24 and 28 weeks of pregnancy. A diabetes Educator should be consulted for advice about diabetes care.

Treatment of Gestational Diabetes involves tight control of blood glucose levels, with dietary assessment (by a Dietitian) of carbohydrate and fat intake and moderate exercise important components of this. Blood glucose levels should be monitored at home several times a day and these should be reviewed by a Doctor on a regular basis. Insulin therapy may be required if these measures fail to control hyerglycaemia (high blood glucose levels).

DIET HINTS

Women with Gestational Diabetes should consult a Dietitian who can recommend an individualised dietary management plan.
- It is recommended that the daily food intake is spread over three meals plus three or more snacks so that blood glucose levels are controlled. An even distribution of carbohydrates over the day also helps prevent the formation of ketones.
- If blood glucose levels still remain high, investigation of the types of carbohydrates being consumed may be required.
- A reduction in the total fat intake (especially saturated fat) is recommended.
- If adequate glycaemic control has not been achieved through these steps, insulin therapy may be required. If this is the case, insulin dosage will be a consideration in the dietary management plan. Adequate amounts of carbohydrate will be required to prevent hyperglycaemia and hypoglycaemia.
- Exercise is a vital component of the dietary management plan.
- A Dietitian should be consulted after the birth to establish a long-term eating plan that will reduce the risk of developing type II diabetes later in life.

PREVENTION

The results of a recent clinical study indicate that increasing maternal physical activity may help reduce the risk of Gestational Diabetes. Women involved in the study who participated in any physical activity during the year prior to their pregnancy had a 56 percent reduced risk of Gestational Diabetes compared with inactive women. It is important for a pregnant woman to seek medical advice before undertaking an exercise programme.

ORGANISATIONS & SUPPORT GROUPS

See the Diabetes Australia topic on the Healthpoint.

PHARMACIST'S ADVICE

Ask your Pharmacist for advice.
1) If you have any queries regarding your medication for diabetes, ask your Pharmacist.
2) Ask your Pharmacist about special diabetic products which are available (e.g. blood glucose testing monitors).
3) Always remember to inform a Pharmacist that you have diabetes when purchasing any oral medication as many mixtures contain sugar (e.g. cough mixture).
4) Try to lose weight if you are overweight. Ask your Pharmacist for the Weight Management - Meal Plan.